Activity. When an elder is house- or bedbound, life can get pretty dull. It’s no fun to be the last to hear news or local gossip! For some elders, conversation is reduced to issues of health and the repetition of old news.

Advice for elders: Think about new things you can contribute to the conversation like memories and stories. Make an effort to engage with visitors.

Advice for helpers: Leave for a while when visitors come by so that the elder will have something to share later. If appropriate, encourage clergy and other visitors to come by. Provide books on tape, large print books or newspapers, etc. — whatever will stimulate thinking and promote conversation.

Boundaries. In the intimacy of a caregiving relationship, it can be difficult to know where one person ends and the other person begins. There is a limit to what each of you can expect the other to know, do, and be. Helpers can’t be on tap every minute of the day. Elders can’t be expected to adapt immediately to a change in schedule just because it’s convenient for the helper. It’s very important to negotiate clearly what each of you can and cannot do to make things go smoothly.

Advice for elders: Accept boundaries. Negotiate if they don’t seem reasonable. Make every effort to be flexible when the helper introduces new activities or has to make a change in schedule.

Advice for helpers: Set boundaries around your time and availability. Give the elder time to transition to new activities or a change in schedule.

Dealing with Systems. Elder and helper both will have to deal with systems outside of the family, including the health care system, the Social Security system, systems of assistance, etc. Often, getting what is needed is challenging for the most educated and stouthearted. For those who are shy, overwhelmed, or simply confused by the complicated regulations and guidelines of these systems, getting help can be a daunting task.

Advice for elders: Provide as much information as you can to your helper so that she can help. This may mean giving access to papers and records that feel private. Find a way to talk about your need for some measure of control.

Advice for helpers: Be sensitive to the elder’s feelings of confusion and upset over loss of control over very private matters. If you find it confusing to deal with outside systems, get help for both you and the elder so that you can make good decisions.

Ultimately, success in the caregiving relationship requires exquisite tact on the part of both people. When both parties go to great lengths to be polite and considerate, each feels acknowledged and appreciated. In that context, elder and helper may discover new depth and satisfaction in their relationship with each other.